Plantar Fasciitis
Do you have pain in your heels and through the arches of your feet first thing in the morning or when you get up after being seated for a while? Or increasing heel pain as the day goes on? These symptoms are typical of plantar fasciitis.
The plantar fascia is a band of tissue that runs along the bottom of your foot with the main responsibility of the plantar fascia being to assist with propulsion, support the arch and absorb shock.
So what exactly is going-on to cause plantar fasciitis?
The pain experienced with plantar fasciitis is tensile strain on the fascia along with irritation and inflammation.
The common contributors to plantar fasciitis are: overuse (prolonged standing or walking), foot structure, lack of calf flexibility, muscle weakness, being overweight, change in activity level, and/or trauma.
Plantar fasciitis is widely seen in weight bearing occupations such as factory workers and nurses as well as in the athletic population.
(Typical) Symptoms
Plantar fasciitis typically presents itself as pain in your heels and through the arches of your feet when you take your first steps after getting out of bed or stand up after being seated for a long period of time. Typically the pain lessens and your feet become less stiff after you take a few steps and let your feet warm-up. Plantar fasciitis may also present as heel and arch pain that increase as the day goes on.
Treatment:
Reduce Load - try to limit activities that cause pain. Although movement that doesn’t cause pain can be helpful for encouraging blood flow.
Stretch! Ankle range of motion is important in not over stressing the plantar fascia - the most important being dorsiflexion (bringing your toes towards your shin). You want to aim for 15-degrees (past 90-degrees) of available dorsiflexion with a straight knee. The ankle is required to dorsiflex for walking - with limited ankle dorsiflexion altered movement patterns place more stress upon the plantar fascia. By stretching your calf complex you can increase you calf flexibility. The tighter your calf muscles are the more stress is placed on your plantar fascia, and the looser your calf muscles are the less stress placed upon your plantar fascia.
Stretch especially before getting out of bed in the morning and after periods of inactivity. Perform foot circles (30 seconds in both directions) and pull your toes back towards your shin while keeping your leg straight before getting up. Perform a plantar fascia stretch, sit with the foot you are stretching over your opposite knee, pull back your toes toward your shin unit you feel a light stretch, hold for 10-15 seconds, rest for 5-10 seconds and repeat X3-5. This helps loosen up your calf muscles and plantar fascia after periods of inactivity.
Throughout the day perform calf stretches by placing your hands against a wall. Place your leg to be stretched behind you with your knee straight, heel flat and foot turned slightly inward to raise your arch. Gradually push your hips forward, towards the wall until you feel a stretch (don’t overdo it). If you need more of stretch step your back leg further behind you, if you require less of a stretch keep your back leg closer toward you.
Ulitize the bottom stair to stretch by standing with the balls of your feet at the edge of a step, keep your knees straight and slowly let your heels drop until you feel a calf stretch.
Hold stretches for 30-60 seconds and then deepen the stretch by bending at the knee and hold for an additional 30 seconds.
Avoid barefoot walking — for the meantime wear supportive footwear as much as possible; especially right when you get out of bed. An orthopaedic sandal makes a great indoor shoe providing your feet with easy to slip on support.
Correct Footwear - plantar fasciitis can also be caused by wearing old or inappropriate footwear. Replace footwear with a shoe appropriate for your biomechanics, foot type and sport. Sudden changes in heel height can change the load placed upon the plantar fascia - moving from a shoe with a 10-mm drop from heel to toe to 4-mm will increase the load on the plantar fascia. A Pedorthist can help recommend the correct shoe for you.
Self-massage – Sit and cross the injured foot over the opposite leg, resting it on your thigh.
Gently pull your toes backward toward your shin until you feel a stretch in the bottom of your foot creating tension in the arch of your foot. In this position you can massage your arch. You can also massage your plantar fascia by running your foot over a lacrosse or golf ball, or a soup can or water bottle. This helps to relax and loosen tight tissue, stimulate blood flow to the arch and improve circulation.
Strengthening the muscles in your feet can also help provide relief. Exercises such as foot tenting and heel raises can help make your feet stronger.
Foot Tenting:
1. Practice one foot at a time. Standing in split stance (one foot slight in front of the other), focus on your foot out in front. Be sure to stand with a slight bend in your knees.
2. Find your foot tripod, with your weight evenly distributed between the base of your big toe, the base of your baby toe and your heel - making a tripod.
3. Now try to bring the ball of your foot closer to the heel, think about shortening the arch of your foot (a very small motion). Do this by thinking about pushing the tips of your toes into the ground (but not lifting the ball of your foot off the floor, or curling/gripping with your toes).
4. Hold for 5seconds, relax and repeat
A helpful cue can be to think about a string pulling the arch of your foot upwards.
Heel Raises
1. Face a wall with your feet pointed forward, place a ball (or rolled up towel) between your heels
2. Slowly raise onto your toes in a controlled manner while squeezing the ball between your heels and driving down through your big toe joints. Use the wall for balance.
3. Pause at the top of your heel raise (squeezing the ball) and then slowly lower your heels back down to the floor.
4. Repeat, slow & controlled for 3 sets of 15-25 (or until fatigue)
Custom-made orthotics or over the counter insoles can be designed to off-load stress placed on the plantar fascia. Orthotics are a proven treatment plan - certain foot mechanics can increase the load placed upon the plantar fascia. Orthotics can redistribute how the load is placed on the plantar fascia. Excessive arch collapse or flattering of the arch lengthens the plantar fascia increasing tension in the plantar fascia and overloading the attachment of the plantar fascia to the heel bone. Supporting the arch reduces stress placed on the plantar fascia removing the extra tensile load. All tissues (muscles, tendons, ligaments, bone) function within a zone of optimal stress. If we load the tissue, in this case the plantar fascia outside of that zone, the tissue will breakdown and injury occurs. With an orthotic device we are altering the loading placed on the plantar fascia to keep it within its optimal stress zone, this helps allow the injured tissue to heal.
Ice for 10-15 minutes at the end of the day or after activity to reduce inflammation and relieve pain — it's a natural analgesic so you won't feel the pain. You can even use a frozen water bottle like a rolling pin under your foot - the rolling will help stretch your foot muscles.
Try a Straussburg sock or dorsiflexion night splint or FS6 compression sleeve
Shockwave Therapy and Platelet-Rich Plasma Therapy are also potentially effective treatment options.
If you are a runner, a change to your running gait can alter the load placed on the plantar fascia. Some may find an increase in running cadence to be beneficial in offloading the plantar fascia, by shortening your stride and landing closer to your centre of mass.
Bee sure to involve a variety of practitioners including pedorthists, massage therapists, physiotherapists, chiropractors, and osteopaths in your treatment plan.
